Provider Demographics
NPI:1770883746
Name:SCHETTINO, JONATHAN R (PHD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:R
Last Name:SCHETTINO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3726 HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-1809
Mailing Address - Country:US
Mailing Address - Phone:401-941-8172
Mailing Address - Fax:
Practice Address - Street 1:1014 W 36TH ST # 205
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2415
Practice Address - Country:US
Practice Address - Phone:410-941-8172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05237103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist